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NPI Code Detail

MEDICARE: DR. JOHN L GREEN MD

MEDICARE: DR. JOHN L GREEN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianNC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00204858OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
113804OTHERNCBCBS OF NC
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073518700
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN L GREEN MD
Provider Business Mailing Address
First Line : PO BOX 2060
Second Line :
City : ALBEMARLE
State : NC
Zip : 28002-2060
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 301 YADKIN ST
Second Line :
City : ALBEMARLE
State : NC
Zip : 28001-3441
Country : US
Telephone Number : 704-984-4385
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2005
Last Update Date : 11/12/2007

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Directions to “ DR. JOHN L GREEN MD” Practice Location

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